Immune cells in chronic prostatitis/chronic pelvic pain syndrome: From pathological mechanisms to therapeutic opportunities.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urological disorder characterized by persistent pelvic pain or discomfort as its core symptom. It is frequently accompanied by lower urinary tract symptoms and significant psychological burden, severely impacting patients' quality of life. The etiology of this condition is complex, and treatment is challenging. Increasing basic and clinical research indicates that abnormal immune system activation and its mediated chronic inflammatory response are central mechanisms in the onset, maintenance, and chronicity of CP/CPPS symptoms. This systematic review examines the roles of key immune cells in the CP/CPPS pathophysiological process, focusing on the phenotypic characteristics and functional states of T lymphocytes (particularly Th1, Th17, and Treg cells), macrophages (M1 and M2 types), neutrophils, and mast cells, as well as their contributions to disease initiation, progression, and chronicity. These immune cells do not function in isolation but collectively construct a dynamic, self-amplifying immunological inflammatory microenvironment through cytokine networks, chemokine gradients, and intercellular interactions. Integrating existing literature evidence, this review mechanistically outlines the abnormal characteristics of major immune cells in CP/CPPS and their roles in inflammation maintenance, pain generation, and tissue remodeling. It emphasizes the mechanisms of Th1/Th17-Treg imbalance, macrophage M1/M2 polarization abnormalities, and the bridging role of neutrophils and mast cells in the immune-neural axis. Furthermore, it summarizes potential therapeutic strategies targeting immune cells and their key signaling pathways, aiming to provide a systematic theoretical basis for CP/CPPS pathogenesis research and precision interventions.